We offer Mohs surgery in Birmingham. This is the only fully private patient unit in the West Midlands to offer Mohs surgery. Mohs surgery is offered under local anaesthetic. The multidisciplinary team ensure that reconstructive services are available from facial and oculoplastic surgeons at the Centre.
Mohs micrographic surgery is the most advanced and sophisticated method of treating skin cancer. It produces cure rates that are higher than for any other technique. This technique was devised almost 60 years ago by Dr. Frederic Mohs, at the University of Wisconsin. It was initially known as chemosurgery, but is now called Mohs micrographic surgery after its inventor.
The most common types of skin cancer to be treated by Mohs Micrographic Surgery are Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC). Both types enlarge from the point where they first occur and usually do not spread (metastasize) to distant parts of the body. If not completely removed, both will invade and destroy structures in their paths. Compared to other forms of cancer, these types of skin cancer can be recognised in their early stages and are therefore easily cured.
It is important to understand how skin cancers grow, as this in turn will help appreciate why Mohs Micrographic Surgery is so useful. Skin cancers begin in the uppermost layer of the skin (the epidermis) and grow to the sides on the surface of the skin and downward, below the skin surface, with root-like extensions. This is comparable to the roots of a weed (see illustration below).
Unfortunately, root-like extensions of skin cancer cannot be seen with the naked eye. Therefore, what is apparent to the naked eye on the surface of the skin may actually be only the visible ‘tip of the iceberg’. If the roots are not treated, then the skin cancer will likely recur. Mohs Micrographic Surgery helps ensure these roots are cleared away completely as removed tissue is examined under the microscope and the tumour is mapped so that guessing the extent of the tumour is eliminated. All other methods of skin cancer treatments require best guessing how wide and deep to treat.
Mohs micrographic surgery involves surgical excision of cancer containing tissue and systematic microscopic examination of all cut surfaces at the time of the operation. It is a highly specialised procedure for the total removal of skin cancers. If the tests show that there is any cancer remaining, then further surgery is performed at the sites where cancer could be. The tissue is tested again and the procedure is repeated until there is the confidence that the whole tumour has been removed. The steps involved are shown in the diagram below.
Mohs micrographic surgery is performed under local anaesthetic. This means the patient is awake during the whole procedure.
Complete removal of a skin cancer, which may involve several surgical stages, is usually completed in half a day. After the surgery, a decision is made as to the best way to manage the wound created by the surgery.
Using the Mohs micrographic surgical technique, the cure rate for skin cancer is very high, often 95% to 98% – even if other forms of treatment have failed. This is the highest cure rate among all treatments available for treating the common skin cancers.
The following chart compares these two methods. We will discuss with you which of these choices will be best in your individual case.
Yes. Most forms of therapy will leave a scar. However, the Mohs micrographic surgical procedure allows any scars to be as small as possible.
When we have determined that the skin cancer has been completely removed, a decision is made about what to do with the wound created by the surgery. Usually there are two choices: (1) to let the wound heal by itself (‘granulation’) or (2) to repair (close) the wound with stitches (either by bringing the wound edges together or with a skin flap or skin graft).
It is impossible to tell with certainty prior to surgery, how deep or wide your wound will be. Although we have a general idea prior to Mohs micrographic surgery, we prefer to wait until the entire tumour is removed before thinking about whether to repair the wound immediately or what kind of repair to select. This concept is like walking over two bridges. One has to cross the first bridge before getting to the second bridge. Furthermore, it may be preferable to wait for a few days after Mohs micrographic surgery before a repair is done. Some repairs are more likely to be successful if they are delayed.
If you would like to discuss the treatment options for skin cancers, then please telephone 0121 285 4540 to arrange an appointment with Dr Rajpar. Mohs micrographic surgery is usually covered by most insurance policies.